Home Guards/ Anagnwadi Worker/ Anganwadi Helper/ ASHA/Gopal Mitra/Adarsh Raithu/Vidya Volunteer/Other Details Note : Please read the Guidelines sent by Department before filling the form, in CAPITAL LETTERS in blue/ black ball point pen only. (Please avoid Short Forms and Abbreviations)
1.Key Employment Details 1.1 Employee ID 1.2 Employee Type
Homeguard/ Anganwadi Workers/ ASHA/ Mandal Samkya/ Gopal Mitra/ Anganwadi Helper/ Vidya Volunteers/ Village Samkya/ Zilla Samkya/ Village Servant/ Village Revenue Assistants/ Adarsh Raitu/ Others __________________________________________ (Please Select the applicable type)
1.3 Surname(ఇంటి పేరు) 1.4 Name
1.5 Gender
Male
Female
1.6 Father / Husband
Father
Husband
Father / Husband Name 1.7 Date of Birth
/
1.8 Marital Status
/
Single
Married
Daily
Monthly
SC
ST
(DD/MM/YYYY) Divorced
Widow
Widower
For Night
Others
1.9 Place of Birth District Mandal Village 1.10 Place of Initial Appointment District Mandal Village 1.11 Terms of Payment
Weekly
1.12 Remuneration 1.13 Office in Which Employee is Working: 1.14 Head of Account: 1.15 Mobile No. 1.16 Personal E-Mail Id 1.17 Community
Minority
BC –A
BC-B
BC-C
BC-D
BC-E
Others 2. Bank and Other key Details
2.1Date of Entry into Service:
/
/
(DD/MM/YYYY)
2.2 Aadhar No 2.3 PAN 2.4 Bank Name 2.5 District of the Bank Branch 2.6 Bank Branch
Page 1 of 2
Finance Department, Government of Andhra Pradesh
Home Guards/ Anagnwadi Worker/ Anganwadi Helper/ ASHA/Gopal Mitra/Adarsh Raithu/Vidya Volunteer/Other Details Note : Please read the Guidelines sent by Department before filling the form, in CAPITAL LETTERS in blue/ black ball point pen only. (Please avoid Short Forms and Abbreviations) 2.7 Bank A/C No 2.8 IFS Code
DECLARATION* The above information is true to the best of my knowledge. I agree to share details of self and family with Government of Andhra Pradesh. I am aware that declaration of wrong details will entail disciplinary action against me.
Home Guards/ Anagnwadi Worker/ Anganwadi Helper/ ASHA/Gopal ...
Note : Please read the Guidelines sent by Department before filling the form, in CAPITAL. LETTERS in blue/ black ball point pen ... BC-C. BC-D. BC-E. Minority. Others. 2. Bank and Other key Details. 2.1Date of Entry into Service: /. /. (DD/MM/YYYY). 2.2 Aadhar No. 2.3 PAN. 2.4 Bank Name. 2.5 District of the Bank Branch.
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